More evidence needed to show what works in prevention of child abuse

A paper commissioned by The Lancet on child abuse shows more evidence is needed to discover ‘what works’ to prevent child maltreatment.

A collaborative study involving the University of Warwick and academic colleagues from Canada, New Zealand, and America looked at interventions aimed at preventing the occurrence of abuse, and those aimed at preventing its recurrence.

They examined all five major subtypes of child maltreatment – physical abuse, sexual abuse, psychological abuse, neglect and exposure to intimate-partner violence.

Professor Jane Barlow, Professor of Public Health at the University of Warwick's Warwick Medical School, led a press conference on the paper on Tuesday 2 December in the Council Chamber at the Royal College of Paediatrics and Child Health.

Key findings from the paper on interventions show that the strongest evidence about ‘what works’ comes from studies about preventing abuse before it has occurred. These show that interventions such as the Nurse Family Partnership home visiting programme, which begins in pregnancy, and is currently being trialled at 20 sites in the UK, is effective in preventing physical abuse and neglect.

The findings also suggest that the training of the existing childcare workforce in the use of the Triple P Positive Parenting Programme alongside other universal media and communication strategies may also prevent abuse and deserves further research, as do hospital based education programmes that teach new parents about the dangers of infant shaking and ways to handle persistent crying. School based educational programmes appear to have a role in improving children’s knowledge and protective behaviours although it is not yet clear whether they prevent sexual abuse.

Parent-child interaction therapy is one of the few interventions that have been shown to prevent the recurrence of child physical abuse, and the review identifies a number of ways of working with children traumatised by abuse to prevent further impairment.

The evidence also suggests that children who are removed from abusive homes and placed in foster care have better outcomes, as do children who are not later reunified with their biological parents. Enhanced foster care, leads to better mental health outcomes for children compared with traditional foster care.

Professor Barlow said: “While there are a number of ways of working with children traumatised by abuse to prevent further impairment, the findings show that once abuse has occurred we know very little about how to intervene with parents to prevent its recurrence. We need to know more clearly what works, and this needs governments to invest in research on the sort of interventions that have been highlighted as potentially effective. A commitment is needed across disciplines to apply evidence-based principles and link science with policy.”

Notes to editorsThe study 'Interventions to prevent child maltreatment and associated impairment' is co-authored by Professor Harriet MacMillan, McMaster University, Canada; C Nadine Wathen, University of Western Ontario, Canada; Professor Jane Barlow, Warwick Medical School, University of Warwick, UK; Professor David Fergusson, Christchurch School of Medicine and Health Sciences, New Zealand; Professor John Leventhal, Yale University School of Medicine, USA; Heather Taussig, University of Colorado, USA

The press conference will be held on Tuesday 2 December, 10am, in the Council Chamber of Royal College of Paediatrics and Child Health. For more information about this event, contact Tony Kirby, Press Officer, The Lancet, +44 (0) 20 7424 4949, +44 (0) 7920 592635.